Trauma infantile, non vera disforia di genere: i detransizionisti finlandesi rivelano le vere ragioni della transizione

Disforia di genere e detransizione negli adulti: un'analisi di nove pazienti di una clinica per l'identità di genere in Finlandia

Casi clinici Detransizione e rimpianto Autismo, trauma e condizioni co-occorrenti

Authors: Kaisa Kettula, Niina Puustinen, Lotta Tynkkynen, Liisa Lempinen, Katinka Tuisku
Journal: Archives of Sexual Behavior
Year: 2025
Source: pubmed.ncbi.nlm.nih.gov/40394447/

Summary

Finnish clinicians reviewed the records of, and reassessed, the nine adults who came back to their gender clinic in 2018 to 2019 wanting to detransition. Most had had hormones and chest or breast surgery years earlier. Nearly all had serious mental health histories, including depression, anxiety, borderline personality disorder, eating problems, self-harm and childhood trauma or sexual abuse. Looking back, most said their wish to transition came from difficulties growing up, especially as girls, and from unresolved distress, rather than from their gender identity. The clinic then made it easier for detransitioners to return and paid more attention to trauma. The study gives rare clinical detail on detransitioners. But it is tiny, has no comparison group, relies on records and memories gathered after regret, and compares its mental health figures with a different group of patients.

Key findings

Lo studio ha riguardato tutti i nove adulti inviati alla clinica per il genere per adulti di Helsinki per fare detransition nel 2018-2019: sette nate femmine, tutte con rimpianto grave, e due nati maschi con rimpianto lieve.
In media avevano 25 anni alla prima diagnosi e 33 alla valutazione per la detransition. Il rimpianto ha impiegato in media sette anni a comparire (cinque anni per chi è stato valutato dopo il 2010).
Otto avevano subito un intervento di asportazione o di ingrandimento del seno e quattro l'asportazione di utero e ovaie. Tutti tranne uno hanno avuto bisogno di un trattamento medico per fare detransition.
I problemi di salute mentale erano molto comuni: disturbi dell'umore nell'89%, disturbi d'ansia nel 78%, disturbo borderline di personalità nel 56% e disturbi o sintomi alimentari nel 78%. Sei avevano subito abusi sessuali o stupro.
Alla valutazione per la detransition, cinque si identificavano con il proprio sesso di nascita, tre come non binari e uno ancora come transgender.
Alla domanda sul perché avessero fatto la transizione, sei hanno detto che crescere come donna era stato difficile. Altri motivi comprendevano il non sentirsi adatti, i traumi e, in un caso, l'aver scambiato l'essere gay con l'essere transgender.
La clinica ha cambiato il proprio modo di lavorare: nessun invio necessario per tornare, collaborazione più stretta con gli psichiatri dei pazienti, terapia gratuita di breve durata e formazione del personale a mantenere la neutralità.
Gli autori affermano che i risultati non sostengono né la chiusura dei servizi di transizione né la transizione senza una valutazione adeguata.

Abstract

The aim of this study was to analyze the pathways of detransitioning, which is a rare, but serious complication of gender-affirming treatments (GATs). The patient group consisted of all patients who were referred to the Helsinki University Hospital's Gender Identity Clinic (GIC) wanting medical treatment for detransition from 2018 to 2019. A new assessment was made systematically and retrospective data were collected. The sample consisted of nine patients originally diagnosed with gender identity disorder (F64.0). Seven of them were assigned female at birth and two were assigned male at birth. All seven females at birth had "major" regret and both males at birth had "minor" regret. All patients except one male assigned at birth wanted their previous GAT to be reversed. The mean regret time (i.e., time from the first diagnosis of F64.0 to the beginning of the new evaluation period) was seven years. The detransitioners had a high number of psychiatric diagnoses. Childhood trauma, sexual abuse or rape, eating disorder symptoms, borderline personality, and psychotic symptoms were common among detransitioners. Retrospectively, the patients reported that the need for transitioning in the first place was not the transgender identity or gender dysphoria, but reasons related to the maturation process and unresolved psychological stressors. An assessment made by the psychologist at the GIC revealed childhood trauma and severe challenges in parenting and attachment. It is important to acknowledge, support, and evaluate those regretting treatments and/or detransition, and to learn from them.

Conclusion

Even though most adults seeking gender-affirming treatment benefit from it and are satisfied with the treatment, it is important to acknowledge, support and evaluate those regretting treatments and/or who wish to detransition, and to learn from them. Those who detransition have a high amount of childhood and sexual trauma, eating disorder symptoms, borderline personality disorders and psychotic symptoms. Evaluating and treating serious psychiatric illnesses first, to determine if the patients' dysphoria resolves without gender-affirming treatment, might reduce the cases of detransitioning. Sufficient psychotherapy might help prior to irreversible gender-affirming treatment. The need for more research is urgent, and a wider, unprejudiced voice in public discussion about detransitioning and regret is needed. It is important to encourage detransitioners to notify the gender identity clinic that they detransitioned, as it would provide valuable information to clinicians about patient outcomes. The results of this study should be used to inform the evaluation process, counseling, informed consent, and medical decision-making for patients with gender dysphoria. The results do not support eliminating transition services nor do they support proceeding to transition without adequate evaluation.

Methodological limitations

Only nine people: The authors admit it is hard to generalise, yet they still make clinical recommendations. Figures such as 89% are based on counts of fewer than ten people.
No comparison group: Without similar patients who didn't detransition, the study can't show that trauma or mental illness predicts detransition, rather than being common among all clinic patients.
Not a typical group: Only detransitioners who came back to this clinic for treatment or a legal gender change were included. The authors cite surveys suggesting only 24 to 29% of detransitioners tell their clinic.
People left out after the fact: Of 13 people found, three first assessed at another clinic (Tampere) were left out, as was one who developed psychosis (losing touch with reality) after starting treatment. Leaving that person out removes a relevant kind of harm.
Looking back after regret: Reasons for transitioning were taken from interview records made after patients had come to regret it, and may be coloured by how they see things now.
Sorted by clinic staff: Patients' reflections were taken from notes and sorted by one psychiatrist (one of the authors), with no independent second person checking.
Measures changed over time: Gender identity questionnaires and a gender and life satisfaction scale were only added in 2018, so there is no like-for-like comparison with the first assessment.
Regret not measured with a tested tool: 'Major' and 'minor' regret used Pfäfflin's 1993 categories, made for regret after surgery, and were judged by the clinicians.
Gaps in relationship data: A questionnaire on how people form close relationships was filled in by only six of nine patients, and the psychologist assessed eight. The gaps aren't explained.
Numbers don't match: The discussion says substance use disorders rose from 16% to 56%, and that eating disorders were 'rare (2%)' at first assessment. These don't match the counts in the paper's own table.
Unfair comparison: The mental health rates are compared with a 2014 group of transgender people (Heylens et al.) at a different time and place, so how much higher they are can't be measured reliably.
Claims go beyond what the study can show: The conclusion that treating mental illness first 'might reduce' detransition is untested, since all patients had been through the clinic's mental health assessment (though three started hormones on their own and two had private chest surgery before it was finished).
Old cases: First assessments took place between 1996 and 2014 at an adult clinic, so the findings may not reflect today's younger patients whose distress began in their teens.
Clinic judging itself: The work was funded by Helsinki University Hospital research money, and the authors are assessing their own clinic's process, though they declare no conflicts.

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Summary

Key findings

Abstract

Conclusion